Harefuah
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Abdominal pain is a frequent complaint. In this report, a woman who presented with abdominal pain was found to have a contained rupture of the abdominal aorta that extended into the retroperitoneum. ⋯ The patient described, however, did not have an aneurysm, as illustrated by the abdominal CT scan and surgical findings. Therefore, abdominal or back pain may be caused by a rupture of the aorta, even in the absence of an aortic aneurysm.
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Multicenter Study
[Percutaneous discectomy and intradiscal radiofrequency thermocoagulation for low back pain: evaluation according to the best available evidence].
Within the framework of evidence-based medicine, high quality randomized trials and systematic reviews are needed for new medical treatment. Clinicians should conscientiously, explicitly and judiciously use the best current evidence in making decisions about the care of individual patients. This paper summarizes the best available evidence from systematic reviews and randomized controlled trials concerning two minimally invasive procedures: percutaneous discectomy and percutaneous intradiscal radiofrequency thermocoagulation. ⋯ Results of systematic reviews were retrieved from four leading evidence-based databases: the National Institute for Clinical Excellence--NICE, which is an independent organization responsible for providing national guidance on treatments, the Cochrane Library, which is the largest library world-wide for systematic reviews and randomized controlled trials, the Center for Review and Dissemination (CRD) at the University of York, which undertakes reviews of research about the effects of interventions in health and social care and finally, a search via Medline. The results from those systematic reviews and randomized trials shows that, at present, unless or until better scientific evidence is available, automated percutaneous discectomy and laser discectomy should be regarded as research techniques. Radiofrequency denervation can relieve pain from neck joints, but may not relieve pain originating from lumbar discs, and its impact on low-back joint pain is uncertain.
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Mechanical ventilation is one of the most important technologies used in critically ill patients. In many patients, the use of mechanical ventialtion and weaning from mechanical ventialtion may be complicated by occurence of positive end expiratory pressure (PEEP) which is created by the mechanical and physiological properties of the pulmonary system and the mechanical ventilator. In order to minimize the detrimental effects of spontaneous PEEP, which is also termed intrinsic PEEP (PEEPi) or autoPEEP, clinicians should be aware of the mechanisms leading to PEEPi, and the possible ways of diminishing it. This review will present some aspects of PEEPi including the most common ways of reducing it and it's deleterious effects.